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❑ Keller Canyon ❑ Ox Mountain, ❑ Newby Island ❑ Forward <br /> Sanitary Landfall Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bai)ey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pitt'%urg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 t 'None(650)726-1819 Phone (408) 945-2800 Phone(209) 982-4298 <br /> Fax(925)458-9891 Fax tM0)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO, <br /> 7 ELEVEN <br /> MAILING ADDRESS _3432 <br /> P O BOX 711 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> DALLAS TX 75221-0711 ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE <br /> O TY VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIG NAT RE OF AUTHORIZED AGENT/TITLE DATE <br /> r <br /> TOR S CERTIFICATION I by th a above named ma rdoua <br /> watts as defined by 40 CFR Part 1 title 22 of eWom a a been properly <br /> dstafbed,daaaified and nd is in p el d or tro a tordrng to applicable <br /> Norm,AND,if the waste is a treatment l of rsatricted hazardous waste <br /> to the Land Disposal Restrictions t ce H war t the waste has been treated in RECEIVING FACILITY <br /> &=dares with the requirements of 40 CFR Pert 222268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL U SLUDGE <br /> O CONSTRUCTION, ❑WOOD <br /> O DEBRIS ❑OTHER <br /> 0 SPECIAL WASTE .., .. .,__..., <br /> GENERATING FACILITY <br /> 7 ELEVEN#19976 1394 NORTH MAIN STREET <br /> SPORTIER i NOTES VEHICLE LICENSE NUMBED I TRURK NUMBER <br /> TIM A MANLEY TRUCKING IN <br /> ADDRESS <br /> 9151 OMBER ROAD <br /> CITY,STATE,ZIP <br /> -- lSACRAMENTO-CA 958Aw.� 4 <br /> PHONE END DUMP' BOTTOM DUMP TRANSFER <br /> SIG TU AUTHORIZED AGENT OR DRIVER DATE ROL FF S FLATS D VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 1 hereby certify that the above named material has been 16 YARDS <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> O SOIL <br /> REMARKS <br /> O CONSTRUCTION <br /> FACIE TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATILIBE OF J QTHORWD AG ENT DATE <br /> f 1 a WOOD <br /> r <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULIjb4fiWBX MADE P OR :00 Y P ORTO ECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOI DAIL LIVERIES MUST BS SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> SALES COPY MANIFEST 0 2 2 51 0 6 <br />